"Agua con azúcar y un chin de sal": Implications of Self-Care Practices and Health Perceptions of Hypertension in the Dominican Republic

PURPOSE: Hypertension is a highly prevalent cardiovascular risk factor that has become increasingly important in global health.1,2 Understanding the social, political, and economic production of distress and disease has been identified as an important areas to inform responses to health disparities.3 While effective chronic disease management could lead to a considerable decrease in morbidity and mortality related to hypertension, poor treatment adherence remains a significant barrier to effective hypertension management in the Dominican Republic and in the U.S. Using Kleinman's Explanatory Model of Illness (1978)4, this pilot study explores: 1) Dominican health beliefs, perceptions, and self-care practices related to la presion; 2) the individual strategies that contribute to the management of la presion; 3) the personal and social meaning of la presion. METHODS: A post explanatory mixed methods approach was used to collect qualitative and quantitative data. Using non-probability purposive sampling, 15 Key Informant interviews, 49 semi-structured participant interviews, and 79 medical chart reviews were conducted from July to August 2011 in 4 rural communities in the Puerto Plata region of the Dominican Republic. RESULTS: Among study participants, 31% demonstrated improvements from baseline blood pressure readings from uncontrolled to controlled blood pressure, while 33% of participants demonstrated no change from uncontrolled baseline blood pressure readings. 40.5% indicated eating, drinking, or doing something else besides taking medication. In response to an open-ended question about causes of la presion, heat was mentioned by 36% of study participants. Responses indicated that there is a high degree of awareness of la presion within their community.